The past 6 months have been a rollercoaster, and, to be honest, I’ve been waiting to be on the rise before posting any sort of formal “comeback update.” But it’s just about June and here we are: I’ve got a completely different diagnosis than from where I started, and I’m still waiting for things to turn around. BUT IT WILL TURN AROUND, especially since I’m now understanding the root of the issue. It has to.
Post-Philly Marathon, I took an extended running break. At the time, my symptoms ranged from:
- Bilateral hamstring tightness and sciatic pain that radiated down one leg.
- Deep, aching pain in my butt – right side worse than the left – but both were definitely affected, especially while sitting.
- SI joint/back pain that varied in discomfort level, but painful while bending back, to the right side, and occasionally while standing on one foot. My SI joint also started to noticeably pop and “clunk” into place when I shifted my hips/back.
- I had coccyx (tailbone) pain and tightness in November, but it cleared up after Philly.
- I never had pain while running – which is why I think things got so bad. In fact, I had conversations not only with a licensed MT, but also my doctor, who told me that if I didn’t have pain while running, I’d be ok, and could still run. So that’s what I went with. Because the symptoms were always so diffuse, I assumed I was just super tight.
I took off the entire month of December, but when I started on some easy runs in January and realized the pain wasn’t gone, I immediately contacted my doctor, who ordered an MRI. The MRI showed swelling around the hamstring attachments, as well as “stress related” bilateral sacral swelling. But, after discussing the reading with my doctor, she didn’t think the rehab focus should be on the sacrum. Evidence and physical examinations pointed to the issue being hamstring-related, and I was also very receptive to hamstring & SIJ dry needling. She believed that the sacral swelling was just “part of the bigger picture” and advised me not to worry about it. So I didn’t, and I rehabbed the shit out of my hamstrings.
My PT, who is incredible, not only dry needled my butt on a weekly basis…but he also created 3 phases of a comprehensive hamstring strength program, to be done in the gym where I work. He told me the rehab process could take a long time, but there’s no logical reason as to why I shouldn’t get better. In conjunction with the lifting program, I was also doing small runs: the idea with tendon injuries is that you can (and should) still load the affected area to a small degree. The key is to find a happy medium where the activity level won’t increase symptoms. For me, the happy medium seemed to be ~20 minutes of slow running. So that’s what I did about 3-4x/week.
By the end of February, things were really looking up: I was getting strong as shit and the tightness on my left side had subsided. The only issue? The right side. It just wouldn’t get better…so I discussed my options with my doctor and decided that PRP injections could be the answer to all my problems.
PRP, a relatively newer solution for tendon and joint rehabilitation, is where platelets (from your own blood) are centrifuged and re-injected into the injured area. The hope is that the injections release “growth factors that recruit and increase the proliferation of the reparative cells.” So, basically, your injury receives all of the super-duper healing powers of your very own blood. The idea is that the injection not only heals, but it also repairs tissue damage. AND, since it’s yourself going into yourself, the side effects are virtually non-existent.
The only downfall of PRP? The fact that it’s not 100% guaranteed to work. And that it’s $$$$$. Most insurances don’t cover the cost of PRP injections, so this is a pricey procedure that can cost anywhere from $300 upwards to $1500-2000. I was very lucky in that I was quoted on the lower end of pricing…so I went for it. At this point, I believed I needed a supraphysiological solution to my problem.
Leading into the injections, my PT actually granted me the go-ahead to do some longer runs. The rationale was: if I was going to need to shut things down post-PRP anyway, might as well do what I love. So over the course of a couple weeks, I took my mileage from 10-15 MPW (which is where it was sitting during the rehab) to 20-30 MPW, and also threw in a couple small fartlek runs for good measure. I ran 98 miles in the month of March, and honestly, it was AMAZING to run again. By the third week of consistent running, I was feeling really strong and actually found some turnover in my legs. The downside is that I definitely knew my body was still banged up: again, I was never in pain while running, but the post-run tightness was still apparent. I was counting down the days to the PRP injections, and also feeling really optimistic that they would be the solution to my issues.
My injection was scheduled for the morning of March 31st, and while everyone’s post-PRP protocol differs, I was instructed to ambulate on crutches for 48 hours post-PRP, followed by 10 days of light stretching before getting back into running and other heavy strength training. Pre-PRP, I was told to hold off on taking ibuprofen and to drink plenty of water for the blood draw.
My injection was done without ultrasound (some docs use ultrasound…mine did not) and the entire process was pretty anticlimactic. My blood draw yielded enough for injections in two locations in my leg, so I received two shots–one towards the inside of the hamstring attachments, and a second that was directly in the middle of my leg.
I was very nervous going into it; I had heard the shots would be excruciatingly painful. One blog review I read described it as more painful than childbirth. While the needle was super long, the pain honestly wasn’t terrible. I consider the pain from dry needling jolts to be worse. (Also keep in mind that my new doctor thinks that the leg pain is actually stemming from a back/sacrum issue and NOT the hamstrings…so I’m wondering if my lack of experiencing intense pain during the injections is a reflection that the issue was never hamstring-related to begin with.)
My hamstring was extremely sore after the injections and I pretty much spent the weekend (they were done on a Friday) hanging out on the couch. I didn’t want to do anything that would jeopardize their effectiveness, so I took the doctor’s instructions of “light activity” very seriously:
- The first 1-2 days following the injections, I was extremely sore and tried not to move the area at all.
- The first week following the injections, I kept my exercising to arms-only lifting and some brisk walking on non-consecutive days.
- 7 days after the injections, I started incorporating in low-level PT exercises (step-ups, clam shells, physioball hamstring curls, banded leg lowers, etc.)
- 16 days after the injections, I went for a 20 minute run, which was done the weekend of the Boston Marathon.
Because so many people have asked about PRP, I also recorded my pain level for the immediate days following the injections:
Day 1 – Super sore. Nervous to stretch or move hamstring.
Day 2 – Sore and awkward to sit.
Day 3 – Still awkward to sit, but more because I feel like a broken bird.
Day 4 – Not sore like it felt immediately following the shot, but felt pretty irritated…similar to how it feels after running.
Day 5 – Walked on the TrueForm and didn’t feel right.
Day 6 – Sore in new places (posteriorly, on same leg) from the walking.
Day 7 – Holy shit I actually think something might be the TINEST bit different!
Day 8 – Identical to day 7.
Day 9 – Walked on a TM & did PT exercises. Movements that used to bother it (eg – tensing quad & glute) no longer trigger pain.
Days 10 – A little sore from PT exercises, but noticing a definite difference in pain levels.
Day 11 – Took a break from PT exercises because was SO SORE, even after simple, unweighted stuff. Realizing how quickly strength goes away when you don’t use it! Difficult to gauge tendon pain levels when sore.
This brings us to mid-April, which was a turning point, because things suddenly started getting progressively worse. The weekend of the Boston Marathon was spent walking, (some) light jogging, and sleeping on a floor. I was also under a great deal of stress because of some life changes. When I returned home after the marathon, my back felt horrible–my pain was almost as bad as it was in the fall. I saw a new massage therapist who seemed to temporarily help…but then the next weekend, I had a work seminar: think little sleep and sitting all day for two days straight.
The next day I saw my PT for dry needling. In the past, dry needling had been extremely effective. Unfortunately, this time, it did little to help my symptoms. My PT said it was the worst he’s seen me since January. At this point, it was clear that the pain was originating from my back and NOT my hamstring.
I messaged my original orthopedic doctor and expressed to her that not only was the PRP ineffective, but I also believed that my pain was no longer stemming from my hamstring, and I feared there was something wrong with my back. She immediately referred me to a spine ortho, and I fortunately was able to see him that week.
I walked into my appointment with the spine doc expecting to not really get answers because I assumed I’d need to get another MRI or CT scan. After chatting about my symptoms, he opened the MRI of my pelvis from January. You know: the one where I was told to “not focus on” the swelling in my sacrum?
He asked me where I had pain. He then glanced at the imaging, looked at me like I had 6 heads, and said, “uh, well yeah. You’re not pointing to your back, Mary. You’re pointing to your sacrum. You still have pain in your sacrum because of these stress fractures that showed up in January. They probably haven’t healed yet. BUT because you’re complaining of sciatic pain, there’s a possibility that you could also have a disc herniation, so we’ll get another MRI to rule that out.”
I’m sorry, what?
“Wait. Did you just say stress fractures?”
He then proceeded to show me the arrows on the MRI that pointed to the bilateral swelling in my sacrum, and also used the words “stress fracture” and “stress reaction” interchangeably. Even though the original reading didn’t report a definite fracture line, he still seemed to think that the sacrum is the cause of everything.
“But wait. We’ve been treating a hamstring injury for 4 months,” I said.
His response? “Yeah, I don’t know why. It’s clear in your MRI that this was an issue back in January.”
I walked out of his office completely stunned, and proceeded to drink a bottle of wine that evening.
In the meantime, the second (lumbar) MRI was negative (yay!) for herniations, stenosis, and other underlying pathologies. SO, because it’s been 6 months and I’m still in pain, I will be receiving diagnostic injections of lidocaine into my SIJ to confirm or refute that the pain is, in fact, emanating from the sacral region. I will also be receiving a little cortisone to hopefully help with the inflammation in the joint. I’m not a huge fan of getting cortisone in an area where the bone was clearly already weakened; but at this point, I’m feeling pretty helpless and nothing I’ve done superficially has helped. When I asked my doctor whether or not my sacrum was still swollen in the most recent MRI, I was told that there is “some resolution,” but because of the original findings, it is still a reasonable concern.
Since hearing the new diagnosis, I’d like to say I’m feeling some sense of closure, and that I’m on the road to recovery; but unfortunately, I don’t know what to think anymore.
Probably the most overwhelming issue is that things are just. not. improving, despite my attempts to continuously do the right things (but, hey, I can now do chin-ups, so maybe I’m winning this battle after all). 🙂
I’ve spoken to a couple people who’ve experienced sacral stress fractures, and the symptoms have ranged from “omg it was very acute and I couldn’t move” to “yeah, it took awhile to figure it out and I also had phantom ‘hamstring’ pain,” –and I obviously relate more to the latter, but if you’ve experienced anything like this, I’d love to hear from you.
Here’s to hoping that the next time I write a training update, I’ll be able to talk about how I went on a short run and it was amazing and wonderful. Until then, I’ll keep on keeping on, and vow to never take running for granted ever again.
